Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis

Marson, B. A.; Deshmukh, S. R.; Grindlay, D. J. C.; Scammell, B. E.

Abstract

Aims
The aim of this review is to evaluate the available literature and to calculate a pooled diagnostic sensitivity and specificity for the different alpha-defensin test systems to diagnose peri-prosthetic infection.

Materials and Methods
Studies using alpha-defensin or Synovasure to diagnose periprosthetic joint infection were identified from systematic searches of electronic databases. Study quality was evaluated using the QUADAS tool. Meta-analysis was completed using a bivariate model.

Results
Eleven eligible studies were included. Median QUADAS score was 13 [I.Q.R. 13-13] out of 14. Significant conflicts of interest were identified in five studies.
Pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% CI 0.91-0.98) and specificity 0.97 (95% CI 0.95-0.98) for four studies with a threshold level of 5.2mgl-a. Pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74-0.92) and specificity was 0.90 (95% CI 0.91-0.98). There was a statistically significant difference in sensitivity but not specificity.

Conclusion
Laboratory based alpha-defensin testing remains a promising tool for diagnosing periprosthetic joint infection. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are essential before the widespread adoption of the lateral flow cassette alpha-defensin test.

Take home message
Alpha defensin testing for periprosthetic joint infection has excellent sensitivity and specificity when performed in a laboratory.
The pooled sensitivity and specificity is much lower when results are combined for the lateral flow cassette (Synovasure devise)

Citation

Marson, B. A., Deshmukh, S. R., Grindlay, D. J. C., & Scammell, B. E. (2018). Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis. Bone and Joint Journal, 100-B(6), 703-711. https://doi.org/10.1302/0301-620x.100b6.bjj-2017-1563.r1

• Journal Article Type: Article
• Acceptance Date: Feb 13, 2018
• Online Publication Date: Jun 1, 2018
• Publication Date: Jun 1, 2018
• Deposit Date: Dec 9, 2020
• Publicly Available Date: Dec 9, 2020
• Journal: The Bone & Joint Journal
• Print ISSN: 2049-4394
• Electronic ISSN: 2049-4408
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 100-B
• Issue: 6
• Pages: 703-711
• DOI: https://doi.org/10.1302/0301-620x.100b6.bjj-2017-1563.r1
• Keywords: hip; knee; infection; diagnostic test; elbow; shoulder
• Public URL: https://nottingham-repository.worktribe.com/output/5129389
• Publisher URL: https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.100B6.BJJ-2017-1563.R1